Application of preoperative thoracoscopic pericardial exploration in local central lung cancer / 肿瘤研究与临床

Objective To discuss the security and reliability of preoperative thoracoscopic pericardial exploratory and to evaluate of the surgical indications.Methods Video full-assisted thoracoscopic pericardioscopy has been implemented in 41 central type lung cancer cases before radical resection.Results Video assisted pericardioscopy group underwent thoracotomy lung resection with procession of intrapericardial pulmonary artery in 8 cases (partial pericardial resection in 2 cases),with pulmonary vein in 10 cases,and out-pericardial lung resection in 9 cases.Spiral CT projections were consistent with surgery was only 65.8 ％.The average time of explorationa was (23±10) min.Conclusion Except for widely used in pulmonary wedge resection and lobectomy,video-assisted thoracoscopic pericardial exploration can improve resection rate and survival rate in central type lung cancer patients which can reduce the need for exploratory thoracotomy.

Tumores do pericárdio / Pericardial tumors

O acometimento neoplásico do pericárdio deve ser sempre suspeitado em pacientes com neoplasia, uma vez que os sinais e sintomas são inespecíficos, assim como os achados em exames gerais. O acometimento neoplásico pericárdico é comumente metatástico e se manifesta com sinais de restrição. O diagnóstico que pode ser realizado com maior precisão pela biopsia pericárdica citológica, em particular com auxílio de pericardioscopia, e tem importância, já que a pericardite neoplásica pode impor maior gravidade a estes pacientes. O tratamento direcionado para a doença de base e as possibilidades terapêuticas locais pericárdicas permitem que uma grande porcentagem de pacientes fique livre da recorrência da doença.

Neoplastic involvement of the pericardium should always be suspected in patients with cancer, since the signs and symptoms are nonspecific, as well as the findings in general examinations. Neoplastic pericardial involvement is often metastatic and it manifests with signs of restriction. The diagnosis can be more accurately performed with pericardial biopsy and cytology, in particular with the aid of pericardioscopy, which is quite important because neoplastic pericarditis may impose more severe risk in these patients. Treatment directed to the underlying disease and therapeutic possibilities of pericardial neoplasms allow a large percentage...

Utilidade da pericardioscopia no diagnóstico de derrame pericárdico / Usefulness of pericardioscopy in the diagnosis of pericardial effusion

O pericárdio pode ser afetado por doenças infecciosas, neoplásicas, inflamatórias e metabólicas. Muitas condições exigem tratamentos específicos, de forma que um diagnóstico preciso é importante. Assim, a biópsia do pericárdio tem um papel importante na avaliação dos derrames pericárdicos. A pericardioscopia oferece a vantagem da tradicional abordagem subxifóide ao permitir acesso a partes do pericárdio que não poderiam ser alcançadas através de palpação digital, bem como visibilização direta através da janela subxifóide ou toracoscopia. Reportamos o caso de um paciente com grande derrame pericárdico e massa mediastinal não-diagnosticada, em quem a pericardioscopia videoassistida foi fundamental no diagnóstico e tratamento da doença.

The pericardium can be affected by infectious, neoplastic, inflammatory and metabolic diseases. Many conditions require specific treatment and, consequently, an accurate diagnosis is important. Therefore, the pericardial biopsy has an important role in the evaluation of pericardial effusions. The pericardioscopy offers the advantage of the traditional subxiphoid approach, as it allows access to parts of the pericardium that would not be reached by digital palpation, as well as direct visualization through the subxiphoid window or thoracoscopy. We report the case of a patient with a large pericardial effusion and an undiagnosed mediastinal mass, in which video-assisted pericardioscopy was fundamental in the diagnosis and treatment of the disease.